Helicobacter pylori (HP) infection is considered the most common infectious contagious disease in the world, affecting about 50% of the global population, and is classified by the International Agency for Research on Cancer (IARC) as a class I carcinogen with the highest alert level. China is one of the countries with the highest incidence of H. pylori infection and also one of the countries with the highest incidence of stomach cancer in the world. So is there an optimal time point to eradicate H. pylori? 1. What the hell is H. pylori? Helicobacter pylori parasitizes the gastric mucosal tissues, and H.pylori gastritis is an infectious and contagious disease. Studies have found a close relationship between HP and chronic gastritis, gastric ulcers and even gastric tumors (including gastric cancer and gastric mucosa-associated lymphoid tissue (MALT) lymphoma). 2. Main mode of transmission – oral-oral or fecal-oral transmission The infection route of H. pylori relies on contact transmission, mainly oral-to-oral transmission, in addition to fecal-to-oral transmission. This mode of transmission suggests that it is closely related to the environment and hygiene habits. HP infection is related to dietary habits, and H. pylori infection in China shows a very obvious phenomenon of family aggregation. Therefore, if someone in the family is infected, it is recommended that family members should also be checked for H. pylori infection. In addition, washing hands before and after meals and using serving chopsticks at meals can reduce H. pylori infection. 3. H. pylori infection is a risk factor for gastric cancer. Epidemiological studies have shown that the risk of gastric cancer in people infected with H. pylori infection is 2-6 times higher than that in uninfected people. It is now recognized that H. pylori infection will lead to chronic gastritis and gastric ulcer. In the process of repeated destruction and repair of gastric mucosa, gastric mucosal epithelial cells may suddenly develop mutations (mucosal atrophy, intestinal metaplasia, etc.), which will be transformed into pre-cancerous lesions, and then there is a certain chance to develop into gastric cancer. 4. Positive Helicobacter pylori does not necessarily lead to gastric cancer. Although gastric cancer has a certain correlation with HP infection, a single HP infection does not necessarily lead to gastric cancer. Besides HP infection, smoking, high salt diet, insufficient vitamin intake and preference for pickled food are also risk factors for stomach cancer. The occurrence of stomach cancer should be said to be the result of the joint action of H. pylori and other factors. 5. Elimination of H. pylori can prevent gastric cancer. Elimination of H. pylori can significantly improve the inflammatory reaction of gastric mucosa, prevent or delay the occurrence and development of gastric mucosal atrophy and intestinal metaplasia, and partially reverse atrophy, but it is difficult to reverse intestinal metaplasia. Currently, H. pylori infection is considered to be the most important controllable risk factor for the prevention of gastric cancer. Implementation of H.pylori eradication therapy before the development of gastric mucosal atrophy and/or intestinal metaplasia may be more effective in reducing the risk of gastric cancer. In addition, eradication of H. pylori HP infection also reduces the recurrence rate in patients after gastric cancer surgery. Those with gastric mucosal atrophy and/or intestinal metaplasia after H.pylori eradication need to be followed up. 6. People found to be HP-positive need not be overly nervous In fact, the HP infection rate of the world population is up to more than 50%, and the benefit of eradicating H.pylori varies among different individuals . According to our treatment consensus opinion, screening and eradication of H.pylori is recommended in individuals at high risk of gastric cancer. proactive treatment is recommended for individuals with greater benefit. Bismuth quadruple (PPI + bismuth + 2 antibiotics) is currently recommended as the main empiric treatment eradication program for H.pylori. Effective regimens should be selected under the right conditions, and cure rates for H. pylori can be as high as 90% with standardized treatment.